Additional Information
Book Details
Abstract
With time at a premium, today's clinicians must rapidly engage their patients while gathering an imposingly large amount of critical information. These clinicians appropriately worry that the "person" beneath the diagnoses will be lost in the shuffle of time constraints, data gathering, and the creation of the electronic health record. Psychiatric Interviewing: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and other Mental Health Professionals, 3rd Edition tackles these problems head-on, providing flexible and practical solutions for gathering critical information while always attending to the concerns and unique needs of the patient.
Within the text, Dr. Shea deftly integrates interviewing techniques from a variety of professional disciplines from psychiatry to clinical psychology, social work, and counseling providing a broad scope of theoretical foundation. Written in the same refreshing, informal writing style that made the first two editions best sellers, the text provides a compelling introduction to all of the core interviewing skills from conveying empathy, effectively utilizing open-ended questions, and forging a powerful therapeutic alliance to sensitively structuring the interview while understanding nonverbal communication at a sophisticated level. Updated to the DSM-5, the text also illustrates how to arrive at a differential diagnosis in a humanistic, caring fashion with the patient treated as a person, not just another case.
Whether the reader is a psychiatric resident or a graduate student in clinical psychology, social work, counseling or psychiatric nursing, the updated third edition is designed to prepare the trainee to function effectively in the hectic worlds of community mental health centers, inpatient units, emergency rooms, and university counseling centers. To do so, the pages are filled with sample questions and examples of interviewing dialogue that bring to life methods for sensitively exploring difficult topics such as domestic violence, drug abuse, incest, antisocial behavior, and taking a sexual history as well as performing complex processes such as the mental status. The expanded chapter on suicide assessment includes an introduction to the internationally acclaimed interviewing strategy for uncovering suicidal ideation, the Chronological Assessment of Suicide Events (CASE Approach). Dr. Shea, the creator of the CASE Approach, then illustrates its techniques in a compelling video demonstrating its effective use in an interview involving a complex presentation of suicidal planning and intent
.A key aspect of this text is its unique appeal to both novice and experienced clinicians. It is designed to grow with the reader as they progress through their graduate training, while providing a reference that the reader will pull off the shelf many times in their subsequent career as a mental health professional. Perhaps the most unique aspect in this regard is the addition of five complete chapters on Advanced and Specialized Interviewing (which comprise Part IV of the book) which appear as bonus chapters in the accompanying e-book without any additional cost to the reader. With over 310 pages, this web-based bonus section provides the reader with essentially two books for the price of one, acquiring not only the expanded core textbook but a set of independent monographs on specialized skill sets that the reader and/or faculty can add to their curriculum as they deem fit.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Praise for Psychiatric Interviewing, 3rd Edition | i | ||
| Advance Praise for the Third Edition | i | ||
| Praise for Previous Editions of Psychiatric Interviewing: the Art of Understanding | iv | ||
| Praise From the Reviewers | iv | ||
| Praise From the Experts and Faculty for Previous Editions | v | ||
| Psychiatric Interviewing | vii | ||
| Copyright Page | x | ||
| Dedication | xi | ||
| Foreword | xii | ||
| Foreword to the 2nd Edition | xiv | ||
| Preface | xvi | ||
| A Few Stylistic Notes From the Author | xxi | ||
| Acknowledgments | xxii | ||
| Table Of Contents | xxv | ||
| Video Table of Contents | xxvii | ||
| I Clinical Interviewing: The Principles Behind the Art | 1 | ||
| 1 The Delicate Dance | 3 | ||
| In Search of a Definition | 4 | ||
| A Bit of Interviewing Examined and the Discovery of a Map | 4 | ||
| Person-Centered Interviewing | 8 | ||
| The Next Step | 9 | ||
| Creating the Therapeutic Alliance | 10 | ||
| First Things First: The Difference Between Engagement and Blending | 10 | ||
| Using Blending to Gauge the Degree of Engagement | 10 | ||
| Conveying Empathy: Traps, Strategies, and Solutions | 14 | ||
| The Empathy Cycle | 14 | ||
| First Phase of the Empathy Cycle: Patient Expresses a Feeling | 15 | ||
| Second Phase of the Empathy Cycle: Clinician Recognizes the Patient’s Feelings | 16 | ||
| Third Phase of the Empathy Cycle: Clinician Conveys Recognition of the Patient’s Feelings | 17 | ||
| Strategic Empathy | 17 | ||
| Interpersonal Stance | 18 | ||
| Empathic Valence | 19 | ||
| Valence of Implied Certainty | 19 | ||
| Valence of Intuited Attribution | 21 | ||
| Basic Guideposts for Effectively Using Strategic Empathy | 23 | ||
| Three Examples of Using Strategic Empathy to Transform Difficult Moments | 23 | ||
| 1: The Paranoid Spiral | 23 | ||
| 2: Transforming Anger with Defusing Statements | 27 | ||
| 3: Shoring Up a Young Empathic Bond with Paraphrasing Statements | 29 | ||
| Generic Paraphrases. | 29 | ||
| The Metaphorical Paraphrase. | 30 | ||
| Frequency, Timing, and Length of Effective Empathic Statements | 31 | ||
| Fourth Phase of the Empathy Cycle: Patient Accurately Perceives the Clinician’s Empathic Statement | 33 | ||
| Fifth Phase of the Empathy Cycle: Patient Communicates an Appropriate Acceptance of the Clinician’s Empathic Statement | 33 | ||
| References | 34 | ||
| 2 Beyond Empathy | 37 | ||
| The Person Before the Letters | 37 | ||
| Inducement of a Safe Relationship | 38 | ||
| Clinician Genuineness | 41 | ||
| Clinician Expertise | 44 | ||
| Collaborative Interviewing Models: New Tools for Enhancing Engagement | 50 | ||
| Solution-Focused Goal Setting | 51 | ||
| The Miracle Question | 52 | ||
| Concluding Statements | 54 | ||
| References | 54 | ||
| 3 The Dynamic Structure of the Interview | 57 | ||
| Introduction: Phase 1 | 58 | ||
| Creating a Safe Environment | 58 | ||
| Addressing Confidentiality | 64 | ||
| Opening: Phase 2 | 66 | ||
| Patient’s Perspective and Conscious Agenda | 68 | ||
| Assessment of the Patient’s Immediate Mental State | 72 | ||
| Clinician’s Perspective of the Patient’s Problems and the Patient’s Unconscious Goals | 73 | ||
| Evaluation of the Interview Itself | 77 | ||
| Degree of Openness Continuum (DOC): Open-Ended Questions, Gentle Commands, Swing Questions, and the Power of Language | 78 | ||
| In Search of an Answer: What Is an Open-Ended Question? | 78 | ||
| Open-Ended Verbalizations | 79 | ||
| Closed-Ended Verbalizations | 81 | ||
| Variable Verbalizations | 81 | ||
| Transforming Shut-Down Interviews | 83 | ||
| Characteristics of Shut-Down Interviews | 83 | ||
| Unlocking Shut-Down Interviews | 85 | ||
| Transforming Wandering Interviews | 90 | ||
| Characteristics of Wandering Interviews | 90 | ||
| Transforming Rehearsed Interviews | 95 | ||
| Characteristics of Rehearsed Interviews | 95 | ||
| Breaking Through a Rehearsed Interview | 96 | ||
| Body of the Interview: Phase 3 | 98 | ||
| The Gathering of the Database | 98 | ||
| Conveying Expertise, the Generation of Hope, and the Return Visit | 100 | ||
| Closing of the Interview: Phase 4 | 101 | ||
| Termination of the Interview: Phase 5 | 108 | ||
| Conclusion | 108 | ||
| References | 109 | ||
| 4 Facilics | 113 | ||
| Sensitively Creating Conversational Interviews | 113 | ||
| Secrets from Everyday Conversation | 113 | ||
| A Solution to the Dilemma | 115 | ||
| Introduction to the Practical Application of Facilics | 116 | ||
| Part I: Learning How to Tag the Flow of the Interview – What Topics, When? | 116 | ||
| Descriptions and Characteristics of Facilic Regions | 116 | ||
| Content Regions | 116 | ||
| Process Regions | 119 | ||
| 1. Free Facilitation Regions | 120 | ||
| 2. Transformational Regions | 121 | ||
| 3. Psychodynamic Regions | 122 | ||
| The Scouting Region: A Unique Combination of Content and Process | 123 | ||
| Part II: Practical Tips for Applying Facilic Principles to the Exploration of Regions | 124 | ||
| Using Time Effectively | 124 | ||
| The Core Conundrum: Well-Timed Tracking Versus Poorly Timed Tracking | 124 | ||
| A Basic Paradigm for Successfully Structuring an Initial Interview | 125 | ||
| Recognizing and Transforming Two Structuring Gremlins | 126 | ||
| 1. Overly Lengthy Scouting Region: The “Five-Minute Fix” | 126 | ||
| 2. The Dead Zone: Two Errors in One | 127 | ||
| The Eight Golden Rules for Structuring Effectively | 128 | ||
| Exploring Content Regions in a Sensitive Fashion | 129 | ||
| Part III: Facilic Gating – The Fine Art of Making Graceful Transitions | 132 | ||
| Gates: The Pathways of Conversational Flow | 132 | ||
| Spontaneous Gates | 132 | ||
| Natural Gates | 134 | ||
| Manufactured “Gates” | 136 | ||
| Referred Gates | 139 | ||
| Phantom Gates | 142 | ||
| Implied Gates | 143 | ||
| Miscellaneous Gates | 144 | ||
| Introduced Gate | 145 | ||
| Observed Gate | 145 | ||
| The Finishing Touches: Summarizing the Principles of Facilics | 145 | ||
| Concluding Comments | 147 | ||
| References | 147 | ||
| 5 Validity Techniques for Exploring Sensitive Material and Uncovering the Truth | 149 | ||
| Understanding the Challenge of Exploring Sensitive Material | 149 | ||
| Validity Techniques: Keys to Eliciting Sensitive Material | 152 | ||
| Cluster One: Techniques for Improving Generalized Recall | 152 | ||
| The Dilemma | 152 | ||
| Anchor Questions | 153 | ||
| Anchor Questions (Focused Upon Time) | 153 | ||
| Anchor Questions (Focused on Location) | 154 | ||
| Tagging Questions | 155 | ||
| Exaggeration | 155 | ||
| Cluster Two: Validity Techniques for Avoiding Miscommunication | 157 | ||
| Defining Technical Terms | 157 | ||
| Clarifying Norms | 157 | ||
| Cluster Three: Validity Techniques for Raising a Sensitive or Taboo Topic | 159 | ||
| Normalization | 159 | ||
| Shame Attenuation | 160 | ||
| Shame Attenuation Used to Bridge From Pain or Situational Stress | 160 | ||
| Shame Attenuation Used to Uncover Aggressive, Unethical, and Antisocial Behaviors | 161 | ||
| Induction to Bragging | 164 | ||
| Cluster Four: Validity Techniques for Exploring a Sensitive Topic Once It Has Been Raised | 165 | ||
| Behavioral Incident | 165 | ||
| Interviewer 1 | 166 | ||
| Interviewer 2 | 166 | ||
| Helping a Patient to Describe an Episode of Intimate Partner Violence (IPV) | 168 | ||
| Limitations of Behavioral Incidents | 169 | ||
| Gentle Assumption | 170 | ||
| Denial of the Specific | 171 | ||
| Catch-All Question | 173 | ||
| Symptom Amplification | 173 | ||
| Validity Technique Combinations | 174 | ||
| Miscellaneous Tips for Specific Situations Where Validity Is a Concern | 176 | ||
| Malingering | 176 | ||
| Gauging Motivation | 178 | ||
| Taking a Sexual History | 180 | ||
| Interview Illustrating the Use of Various Validity Techniques | 181 | ||
| References | 185 | ||
| 6 Understanding the Person Beneath the Diagnosis | 187 | ||
| Introductory Illustration: The Person Beneath the Diagnosis | 187 | ||
| Part I: Phenomena That Hinder the Understanding of the Person | 192 | ||
| Parataxic Distortion | 192 | ||
| Further Problems With Inaccuracy: The Issue of Reliability | 194 | ||
| Part II: Phenomena That Deepen the Understanding of the Person Beneath the Diagnosis | 196 | ||
| Sullivan’s Interpersonal Perspective Revisited | 196 | ||
| Phenomenological Inquiry | 200 | ||
| The Search for Wellness: Patient Strengths, Skills, and Interests | 202 | ||
| Exploring Component | 203 | ||
| Strengths of Knowledge: | 204 | ||
| Strengths of Courage: | 204 | ||
| Strengths of Humanity: | 204 | ||
| Strengths of Justice: | 204 | ||
| Strengths of Temperance: | 204 | ||
| Strengths of Transcendence: | 204 | ||
| Exploring Component | 205 | ||
| Creative Skills: | 206 | ||
| Task Related: | 206 | ||
| Interpersonal Skills: | 206 | ||
| Athletic Skills: | 206 | ||
| Manual Dexterity: | 206 | ||
| Specific Career Training: | 207 | ||
| Exploring Component | 209 | ||
| Part III: Understanding Cultural Diversity – Its Vital Role in the Initial Interview | 211 | ||
| Misperceptions Related to Cultural Biases: Impact on the Initial Therapeutic Alliance | 212 | ||
| Culture Impacting Directly on Treatment Planning in the Initial Interview | 214 | ||
| References | 217 | ||
| 7 Assessment Perspectives and the Human Matrix | 221 | ||
| Clinical Presentation: the Initial Interview | 224 | ||
| The Diagnostic Perspective of the DSM and ICD Systems | 225 | ||
| The Healing Power of Differential Diagnosis | 225 | ||
| Limitations of Formal Diagnostic Systems Such as the DSM and ICD | 227 | ||
| The Loss of Multiaxial Formulation: a Historical Footnote | 228 | ||
| Major Psychiatric Disorders (Other Than Personality Disorders) | 230 | ||
| Personality Disorders | 232 | ||
| Non-Psychiatric Medical Conditions | 233 | ||
| Psychosocial Context and Stressors | 234 | ||
| Level of Current Functioning and Impairment | 234 | ||
| Clinical Application of the DSM-5 | 235 | ||
| Matrix Treatment Planning | 238 | ||
| Introduction | 238 | ||
| Basic Paradigm and History of the Biopsychosocial Treatment Planning Model | 239 | ||
| A Revitalizing Change in Language | 245 | ||
| Matrix Treatment Planning: General Clinical Principles and Specific Applications to Debbie in the Initial Interview | 247 | ||
| First Wing of the Matrix: Biologic | 247 | ||
| Biological Intra-Wing Interventions | 247 | ||
| Biological Inter-Wing Interventions | 248 | ||
| II The Interview and Psychopathology: From Differential Diagnosis to Understanding | 335 | ||
| 9 Mood Disorders | 337 | ||
| Introduction | 337 | ||
| Diagnostic Systems: There Has Never Been a Perfect One and There Never Will Be | 339 | ||
| The Nature of the Dilemma for Front-Line Clinicians | 339 | ||
| Validity Versus Reliability | 339 | ||
| Construct Validity, Face Validity, and Descriptive Essence | 340 | ||
| Categorical Diagnostic Systems Versus Dimensional Diagnostic Systems | 341 | ||
| Categorical Diagnostic Systems | 341 | ||
| Dimensional Diagnostic Systems | 342 | ||
| A Pivotal Step Forward in the DSM-5 | 342 | ||
| First Steps in the Differential Diagnosis of Mood Disorders | 343 | ||
| Clinical Presentations and Discussions | 346 | ||
| Clinical Presentation | 346 | ||
| Discussion of Mr. Evans | 347 | ||
| The Painful World of Anhedonia: Its Role in Diagnosis | 347 | ||
| Uncovering the Neurovegetative Symptoms of Depression | 348 | ||
| What Are the Neurovegetative Symptoms of Depression? | 348 | ||
| Tips for Exploring Early Morning Awakening and Other Sleep Disturbances | 349 | ||
| Sensitively Asking Patients About Libido | 350 | ||
| Gracefully Weaving the Neurovegetative Symptoms Into the Interview | 351 | ||
| The Concept of Melancholia | 352 | ||
| Anxiety: Another Important Dimensional Specifier | 353 | ||
| The Role of Substance Abuse in the Differential Diagnoses of Depression | 353 | ||
| Important Data Points When Taking a Past Psychiatric History | 354 | ||
| Spotting Bipolar I Disorder: Traps and Nuances | 356 | ||
| Bipolar I Disorder | 358 | ||
| Classic Euphoric Mania | 358 | ||
| Psychotic Process in Mania | 361 | ||
| The Importance of Family Members and Collaborative Sources When Delineating Mania | 361 | ||
| Cognitive Deficits in Mania | 362 | ||
| Differential Diagnosis on Mr. Evans and Summary of Key Interviewing Tips | 363 | ||
| Clinical Presentation | 364 | ||
| Discussion of Danny Ramirez | 365 | ||
| Bipolar I Disorder, Mixed Presentation | 365 | ||
| History Repeats Itself: An Evolving Diagnosis | 365 | ||
| A Practical Solution From the DSM-5 | 367 | ||
| “Dysphoric Mania”: One Type of Mixed Bipolar Disorder | 368 | ||
| Differentiating a Dysphoric Mania From an Agitated Depression | 368 | ||
| Three Practical Tips for Spotting a Dysphoric Mania. | 371 | ||
| Historical Tip-Offs That Raise the Suspicion of Mixed Bipolar States in General | 374 | ||
| Over-Diagnosing Bipolar Disorder: A Serious Diagnostic Error | 375 | ||
| Bipolar II Disorder | 376 | ||
| Substance/Medication-Induced Bipolar and Related Disorder | 378 | ||
| Recognizing Suicidal Ideation Unleashed During Partial Manic Responses to a Medication | 380 | ||
| Cyclothymic Disorder and Rapid Cycling | 381 | ||
| Differential Diagnosis on Danny Ramirez and Summary of Key Interviewing Tips | 382 | ||
| Clinical Presentation | 385 | ||
| Discussion of Mr. Whitstone | 386 | ||
| Patient Hesitancies to Admit to Depression and How to Transform Them | 386 | ||
| Cross-Cultural Issues in Recognizing Depression | 387 | ||
| Problems With Concentration and Cognitive Functioning in Depression | 388 | ||
| Spotting Atypical Depression | 388 | ||
| Psychotic Process in Depression | 391 | ||
| Ruling Out Non-Psychiatric Biological Causes of Depression | 391 | ||
| Differential Diagnosis on Mr. Whitstone and Summary of Key Interviewing Tips | 393 | ||
| Clinical Presentation | 394 | ||
| Discussion of Ms. Wilkins | 394 | ||
| The Need to Determine the Persistence of Depressive Symptoms and How to Do It | 394 | ||
| Red Herrings: Disorders That Mimic Major Depressions | 396 | ||
| Tips for Delineating an Accurate History of the Presenting Disorder | 397 | ||
| Ruling Out Peripartum Depressions, Grief, Adjustment Disorders, and V-Codes | 399 | ||
| Differential Diagnosis on Ms. Wilkins and Summary of Key Interviewing Tips | 400 | ||
| Clinical Presentation | 402 | ||
| Discussion of Mr. Collier | 402 | ||
| Techniques for Eliciting a Family History | 402 | ||
| Difficulties in Taking a Family History and How to Transform Them | 403 | ||
| Cross-Cultural Sensitivity When Taking a Family History | 405 | ||
| Family History as a Reflection of Family Dynamics | 406 | ||
| Differential Diagnosis on Mr. Collier and Summary of Key Interviewing Tips | 406 | ||
| References | 409 | ||
| 10 Interviewing Techniques for Understanding the Person Beneath the Mood Disorder | 413 | ||
| Introduction | 413 | ||
| The Pain Beneath Depression | 414 | ||
| Fields of Interaction | 414 | ||
| The Biological Wing of the Matrix | 414 | ||
| The Psychological Wing of the Matrix | 417 | ||
| 1. Depressive Changes in How the World Is Perceived | 417 | ||
| The Window Shade Response | 418 | ||
| 2. Cognitive Changes Caused by Depression | 419 | ||
| Changes in the Flow of Thought and Ideational Caging | 419 | ||
| Cognitive Distortions as Conceptualized by Aaron Beck | 420 | ||
| First Distortion in Beck’s Triad: Negative View of the World | 421 | ||
| Second Distortion in Beck’s Triad: Negative Self-Concept | 421 | ||
| Third Distortion in Beck’s Triad: Negative View of the Future | 421 | ||
| 3. Alterations in Thought Content Found in Depression | 422 | ||
| Depressive Loneliness | 422 | ||
| Depressive Guilt and Self-Loathing | 422 | ||
| Depressive Helplessness | 423 | ||
| Depressive Hopelessness | 423 | ||
| 4. Psychodynamic Defenses and Their Role in Depression | 423 | ||
| The Dyadic Wing of the Matrix | 425 | ||
| The Impact of the Patient’s Depression on the Interviewer | 426 | ||
| How a Clinician’s Behaviors Can Submerge a Depression From View | 427 | ||
| Effectively Addressing Tearfulness | 427 | ||
| The Familial and Societal Wing of the Matrix | 428 | ||
| An Illustration of the Insidious Impact of Depression on a Family | 429 | ||
| Addressing the Pain of Family Members | 430 | ||
| Uncovering Potentially Damaging Family Impacts on the Patient | 430 | ||
| The Impact of Depression on Societal and Cultural Systems | 431 | ||
| Cultural Impacts on the Patient’s Depression | 432 | ||
| The Wing of the Matrix Encompassing Worldview and Spirituality | 433 | ||
| References | 435 | ||
| 11 Psychotic Disorders | 437 | ||
| Introduction | 437 | ||
| The Differential Diagnosis of Psychotic States | 438 | ||
| Clinical Presentations and Discussions | 441 | ||
| Clinical Presentation | 441 | ||
| Discussion of Mr. Williams | 441 | ||
| Phenomenology of Visual Hallucinations and Illusions: Their Diagnostic Implications | 441 | ||
| Recognizing Psychotic Process Induced by Alcohol Withdrawal | 443 | ||
| Recognizing Psychotic Process Induced by Street Drugs | 445 | ||
| Recognizing Medication-Induced Psychosis | 447 | ||
| Effectively Interviewing and Collaborating With Law Enforcement Officers | 448 | ||
| Differential Diagnosis on Mr. Williams and Summary of Key Interviewing Tips | 449 | ||
| Clinical Presentation | 450 | ||
| Discussion of Mr. Walker | 451 | ||
| Spotting Disturbances of Affect as Seen in Schizophrenia | 451 | ||
| Diagnostic Significance of the Presence of Delusions: Delineating Schizophrenia From Delusional Disorders | 452 | ||
| Negative (Deficit) Symptoms of Schizophrenia | 453 | ||
| The Importance of Family Members in Uncovering Psychotic Process | 453 | ||
| Differential Diagnosis Between Schizophrenia and Mood Disorders With Psychotic Features | 454 | ||
| Schizoaffective Disorder and the Schizo–Bipolar Continuum | 456 | ||
| Differential Diagnosis on Mr. Walker and Summary of Key Interviewing Tips | 459 | ||
| Clinical Presentation | 460 | ||
| Discussion of Ms. Hastings | 460 | ||
| Types of Delusional Disorders | 460 | ||
| Paranoid Delusions: Techniques for Uncovering Potential Dangerousness | 464 | ||
| Delusions in the Elderly and Paraphrenia | 466 | ||
| Differential Diagnosis on Ms. Hastings and Summary of Key Interviewing Tips | 468 | ||
| Clinical Presentation | 469 | ||
| Discussion of Ms. Fay | 469 | ||
| The Life Cycle of a Psychosis | 469 | ||
| Delusional Mood | 470 | ||
| Delusional Perception | 472 | ||
| The Emergence of Concrete Delusional Ideation | 472 | ||
| Soft Signs of Psychosis: How to Spot Hidden Psychotic Process | 473 | ||
| Helping Patients to Share Delusional Material | 474 | ||
| Tapping Intense Affect | 474 | ||
| Tapping Odd Language, Illogical Thought, and Idiosyncratic Phrasing | 474 | ||
| Indirect Techniques for Exploring Delusional Material | 474 | ||
| Examples | 475 | ||
| Illustrative Dialogue | 475 | ||
| How to Respond When a Delusional Patient Asks, “Do You Believe Me?” | 475 | ||
| Hallucinations and Other “Hard Signs of Psychosis” in the Normal Population | 477 | ||
| Auditory and Visual Hallucinations in the Normal Population | 477 | ||
| Cultural Competence: Its Importance in Distinguishing True Psychotic Symptoms From Culturally Accepted Behaviors | 478 | ||
| The Interface Between Cultural Phenomena and the Life Cycle of a Psychosis | 479 | ||
| Back to Ms. Fay: An Illustration of How to Tap a Piece of Illogical Thought for Underlying Delusional Material | 480 | ||
| Differential Diagnosis on Ms. Fay and Summary of Key Interviewing Tips | 481 | ||
| Clinical Presentation | 484 | ||
| Discussion of Mr. Lawrence | 484 | ||
| A Deadly Trap: Missing Deliria in Patients With Illnesses Such as Schizophrenia | 485 | ||
| Practical Tips for Spotting a Delirium: The Nature of the Beast | 486 | ||
| Four Cognitive Tests Useful for Recognizing a Subtle Delirium | 488 | ||
| Differential Diagnosis on Mr. Lawrence and Summary of Key Interviewing Tips | 490 | ||
| Clinical Presentation | 492 | ||
| Discussion of Kate | 492 | ||
| Spotting Non-Delirial Psychoses Caused by Underlying Medical Conditions | 492 | ||
| When to Refer for a Physical Exam and What to Do If You Can Perform One | 494 | ||
| Differential Diagnosis on Kate and Summary of Key Interviewing Tips | 495 | ||
| Clinical Presentation | 497 | ||
| Discussion of Ms. Flagstone | 497 | ||
| “Micropsychotic Episodes” Seen in People Coping With Personality Disorders | 497 | ||
| Psychotic Processes With a Rapid Onset/Offset | 498 | ||
| Differential Diagnosis on Ms. Flagstone and Summary of Key Interviewing Tips | 499 | ||
| Recognizing Psychotic Process Triggered by Seizure Disorders | 499 | ||
| References | 502 | ||
| 12 Interviewing Techniques for Understanding the Person Beneath the Psychosis | 507 | ||
| The Pain Beneath Psychotic Process | 508 | ||
| Fields of Interaction | 508 | ||
| I. The Biological Wing of the Matrix | 508 | ||
| Sleep Disturbances in Psychosis | 508 | ||
| Psychotic Disruption of the “Sensation of the Physical Boundaries of the Body” and the Concept of a “Porous Ego” | 508 | ||
| Schneiderian First-Rank Symptoms of Psychosis | 509 | ||
| Exploring Somatic Passivity and “Made Feelings”: The World of the Porous Ego | 510 | ||
| Thought Withdrawal and Thought Insertion | 512 | ||
| Thought Broadcasting (Unintentional and Intentional) | 513 | ||
| Spotting Medication-Induced Akathisia | 514 | ||
| Establishing an Alliance With a Patient Experiencing Catatonia | 517 | ||
| II. The Psychological Wing of the Matrix | 518 | ||
| Auditory Hallucinations: Their Nature, Phenomenology, and Exploration | 518 | ||
| The Directional Location of Auditory Hallucinations | 519 | ||
| The Reality of Auditory Hallucinations to the Patient | 521 | ||
| Distinction Between Auditory Hallucinations and Auditory Illusions | 521 | ||
| The Uniqueness of Auditory Hallucinations | 522 | ||
| Schneiderian Symptoms Related to Auditory Hallucinations | 522 | ||
| The Relationship Between the Patient and the Patient’s Voices | 522 | ||
| Uncovering and Sensitively Exploring Auditory Hallucinations | 524 | ||
| Sensitively Raising the Topic of Auditory Hallucinations | 525 | ||
| Sensitively Exploring the Phenomenology of Auditory Hallucinations Once Raised | 526 | ||
| Illustrative Transcript of a Clinician Exploring Auditory Hallucinations | 527 | ||
| Exploring Command Hallucinations | 528 | ||
| Exploring the Content of Command Hallucinations | 530 | ||
| Exploring the Auditory Quality of Command Hallucinations | 530 | ||
| Exploring the Degree to Which a Patient Feels Able to Resist a Command Hallucination | 531 | ||
| Exploring the Emotional Impact of Command Hallucinations on a Patient | 531 | ||
| Psychotic Disruptions in Cognition, Logic, and Communication | 532 | ||
| How to Safely Interact With an Illogical, Agitated Psychotic Patient | 533 | ||
| Unobtrusively Screening for Paranoid Process, Delusions, and Other Psychotic Process | 534 | ||
| Understanding the Demoralization and Self-Denigration Spurred by Psychotic Process | 537 | ||
| III. The Dyadic Wing of the Matrix | 538 | ||
| Uncovering Social Withdrawal and Recognizing Social Inappropriateness | 538 | ||
| The Impact of Psychotic Process on the Interviewer’s Emotions and Behaviors | 539 | ||
| The Impact of the Interviewer’s Behaviors on Psychotic Process | 540 | ||
| IV. The Familial, Cultural, and Societal Wing of the Matrix | 541 | ||
| Understanding the Exquisite Pain of Family Members | 541 | ||
| Practical Techniques for Engaging Family Members in the Initial Interview | 543 | ||
| Opening the Conversation in an Initial Encounter With a Family Member | 543 | ||
| Tips for Initial Interviews With Family Members on Inpatient Units | 545 | ||
| Talking With Patients About Involving Their Family Members in Assessment and Treatment | 546 | ||
| Cultural and Societal Impacts on Psychotic Process | 548 | ||
| Encountering Culture-Bound Syndromes and Behaviors | 548 | ||
| Missing Culturally Specific Psychotic Process | 548 | ||
| Mistaking Culturally Normal Phenomena for Psychotic Process Redux | 550 | ||
| The Community Mental Health Center as a Subculture | 551 | ||
| Language and Culture: Potential Roadblocks When Uncovering Psychotic Process | 552 | ||
| V. The Wing of the Matrix Encompassing Worldview and Spirituality | 553 | ||
| Psychotic Destruction of the Patient’s Religious Worldview | 553 | ||
| The Personalized Meaning of Psychotic Symptoms to Patients | 554 | ||
| References | 555 | ||
| 13 Personality Disorders | 559 | ||
| Introduction | 559 | ||
| The Mystery of Personality Disorders Revealed: Core Principles and Definitions | 560 | ||
| In Search of a Definition | 560 | ||
| The Gestalt of Personality Dysfunction | 560 | ||
| DSM-5 Definitions of a Personality Disorder | 563 | ||
| Personality Disorders as Reflections of the Social History | 563 | ||
| The Nature of Personality Diagnoses: Abuses and Uses | 565 | ||
| A Cautionary Note | 565 | ||
| The Beneficial Uses of Personality Diagnoses | 566 | ||
| A Useful Metaphor | 570 | ||
| The Etiology of Personality Disorders | 571 | ||
| References | 573 | ||
| 14 Personality Disorders | 575 | ||
| Introduction | 575 | ||
| Section I: A Survey of the DSM-5 Personality Disorders | 576 | ||
| Goals and Limitations of the Survey | 576 | ||
| 1. Anxiety-Prone Disorders | 577 | ||
| Obsessive–Compulsive Personality Disorder | 577 | ||
| Dependent Personality Disorder | 578 | ||
| Avoidant Personality Disorder | 578 | ||
| 2. Poorly Empathic Disorders | 579 | ||
| Schizoid Personality Disorder | 579 | ||
| Antisocial Personality Disorder | 580 | ||
| Histrionic Personality Disorder | 581 | ||
| Narcissistic Personality Disorder | 582 | ||
| 3. Psychotic-Prone Disorders | 583 | ||
| Borderline Personality Disorder | 583 | ||
| Schizotypal Personality Disorder | 584 | ||
| Paranoid Personality Disorder | 585 | ||
| Section II: Common Problems Encountered When Diagnosing Personality Disorders | 586 | ||
| Premature Diagnosis: “Label Slapping” | 586 | ||
| Mistaking Behaviors Shown in the Interview as Personality Traits | 586 | ||
| Problems With Countertransference | 587 | ||
| Inappropriate Hesitation to Make a Personality Diagnosis | 587 | ||
| Section III: Using the DSM-5 to Arrive at a Personality Diagnosis | 589 | ||
| Step | 590 | ||
| Passively Scouting for Clues to Personality Dysfunction | 590 | ||
| Signal Signs | 590 | ||
| Signal Symptoms | 594 | ||
| Actively Limiting the Diagnostic Field With Probe Questions | 596 | ||
| Illustration of a Clinician Limiting the Field of Diagnostic Possibilities | 599 | ||
| Step | 602 | ||
| Illustration of a Clinician Expanding the Diagnostic Criteria of a Specific Diagnosis | 603 | ||
| Verifying the Validity of Patient-Reported Diagnostic Traits | 607 | ||
| Enhancing Validity by Maintaining Engagement | 607 | ||
| Techniques for Verifying Historical Persistency | 608 | ||
| Techniques for Ruling Out State Dependency | 608 | ||
| Verifying Pathological Severity | 609 | ||
| Tapping for Epiphenomena | 610 | ||
| Section IV: Future Diagnostic Systems of Personality Dysfunction and the Usefulness of Dimensionality Today | 613 | ||
| Dimensionality: A Note of Caution | 613 | ||
| The Power of Dimensionality in the Initial Interview | 614 | ||
| Entrance Questions for Exploring Personality Traits | 616 | ||
| Differential Diagnosis of Personality Disorders: A Glimpse Into the Future | 620 | ||
| Building Upon the DSM-5 Categorical System | 620 | ||
| Conclusion | 622 | ||
| References | 623 | ||
| 15 Understanding and Effectively Engaging People With Difficult Personality Disorders | 627 | ||
| Introduction to Object Relations and Self Psychology | 627 | ||
| Goals of This Chapter and Core Definitions | 629 | ||
| Defining Object Relations and Self Psychology | 630 | ||
| What Propels the Development of the Self? | 632 | ||
| The Four Developmental Stages of the Self and Their Clinical Applications | 633 | ||
| Developmental Stage | 633 | ||
| Developmental Stage | 635 | ||
| Winnicott, Merger Objects, and Transitional Objects | 635 | ||
| Signal Signs Arising From Merger Dynamics | 636 | ||
| Signal Symptoms Arising From Merger Dynamics | 638 | ||
| Enhancing Engagement as Related to Merger Objects | 639 | ||
| Kernberg, Splitting, and the Move Towards Mobility | 640 | ||
| Signal Signs Arising From Splitting Defenses | 641 | ||
| Signal Symptoms Arising From Splitting Defenses | 643 | ||
| Enhancing Engagement as Related to Splitting Defenses | 644 | ||
| Developmental Stage | 644 | ||
| Kohut, the Bipolar Self, and the Search for Independent Functioning | 644 | ||
| Signal Signs Arising From the Psychodynamics of the Bipolar Self | 650 | ||
| Signal Symptoms Arising From the Psychodynamics of the Bipolar Self | 651 | ||
| Enhancing Engagement Via an Understanding of the Bipolar Self | 652 | ||
| Complementary Shifts | 652 | ||
| Countertransference: Short-Circuiting a Clinical Gremlin | 655 | ||
| Accepting Idealization | 656 | ||
| Developmental Stage | 657 | ||
| Concluding Comments: on the Utility of Mirrors | 658 | ||
| References | 659 | ||
| III Mastering Complex Interviewing Tasks Demanded in Everyday Clinical Practice | 661 | ||
| 16 The Mental Status | 663 | ||
| Introduction | 663 | ||
| The Impact Status | 664 | ||
| The Mental Status | 665 | ||
| General Characteristics of the Mental Status: What Is It? | 665 | ||
| Documenting the Mental Status | 666 | ||
| Components of the Mental Status | 668 | ||
| 1. Appearance and Behavior | 668 | ||
| 2. Speech Characteristics and Thought Process | 670 | ||
| 3. Thought Content | 673 | ||
| Ruminations | 673 | ||
| Obsessions | 673 | ||
| Compulsions | 673 | ||
| Delusions | 674 | ||
| Thought Concerning Dangerousness to Self and Others | 674 | ||
| 4. Perception | 675 | ||
| 5. Mood and Affect | 676 | ||
| 6. Sensorium, Cognitive Functioning, and Insight | 678 | ||
| References | 681 | ||
| 17 Exploring Suicidal Ideation | 683 | ||
| Introduction | 683 | ||
| Section 1: Risk Factors, Warning Signs, and Protective Factors: Their Role in the Clinical Formulation of Risk | 684 | ||
| Important Distinctions and Critical Limitations | 684 | ||
| Risk Factors Versus Risk Predictors (Warning Signs) | 684 | ||
| Static Versus Dynamic Risk Factors | 686 | ||
| Protective Factors | 687 | ||
| Uncovering and Weighing Risk Factors and Warning Signs: The State of the Art | 688 | ||
| Clinical Illustrations | 688 | ||
| Clinical Illustration | 688 | ||
| Clinical Illustration | 700 | ||
| Risk Factors and Warning Signs: Summary and Effective Utilization | 705 | ||
| Useful Mnemonics | 705 | ||
| Loose Ends and a New Mnemonic | 706 | ||
| Differentiating Between Concerns of Chronic Suicide Risk Versus More Immediate Risk | 707 | ||
| The Tetrad of Lethality: Four Common Indicators That Hospitalization May Be Required | 707 | ||
| Section 2: the Elicitation of Suicidal Ideation, Planning, Behaviors, and Intent | 710 | ||
| 1. Before the Interview Begins: Secrets, Countertransference, and Problematic Myths | 710 | ||
| 2. The Importance of Uncovering Suicidal Ideation and Why It Is Hard to Do So | 713 | ||
| Roadblocks to Sharing Suicidal Ideation | 713 | ||
| Reflected Intent: One of the Master Keys to Unlocking Real Intent | 715 | ||
| Pitfalls of an Incomplete Elicitation of Suicidal Ideation | 716 | ||
| Premature Crisis Resolution | 716 | ||
| Lost Data for the Receiving Clinician | 717 | ||
| The Power of a Thorough Elicitation of Suicidal Ideation, Behavior, and Intent to Save a Life | 717 | ||
| The Issue of Credibility | 717 | ||
| Reaching for Life | 718 | ||
| 3. Setting the Platform for the Suicide Inquiry | 718 | ||
| The “Elicitation of Suicidal Ideation Triad” | 718 | ||
| Step 1 of the Elicitation Triad: Enhancing Engagement With a Potentially Suicidal Patient | 719 | ||
| Step 2 of the Elicitation Triad: Helping the Potentially Suicidal Patient to Share Highly Charged Emotional States | 719 | ||
| Three Gateways to Suicidal Ideation | 719 | ||
| Step 3 of the Elicitation Triad: The Patient Hints at Suicide or Raises the Topic Spontaneously | 721 | ||
| 4. Eliciting Suicidal Ideation, Planning, and Intent Using the Chronological Assessment of Suicide Events (CASE Approach) | 722 | ||
| Background, Rationale, and Limitations | 722 | ||
| The Question of Validity: Its Central Role in the CASE Approach | 724 | ||
| Two Validity Techniques for Sensitively Raising the Topic of Suicide | 726 | ||
| Normalization | 726 | ||
| Shame Attenuation | 726 | ||
| A Note on Word Choice: “Killing Yourself” Versus “Committing Suicide” | 727 | ||
| Five Validity Techniques Used to Explore the Extent of Suicidal Ideation | 728 | ||
| Behavioral Incident | 728 | ||
| Gentle Assumption | 728 | ||
| Denial of the Specific | 729 | ||
| Catch-All Question | 730 | ||
| Symptom Amplification | 730 | ||
| The Macrostructure of the CASE Approach: Avoiding Errors of Omission | 731 | ||
| The Microstructure of the CASE Approach: Exploring the Four Specific Timeframes | 732 | ||
| Step 1: The Exploration of Presenting Suicide Events | 732 | ||
| The Concept of Creating a Verbal Video | 735 | ||
| More Tips on Making a Verbal Video With Behavioral Incidents | 737 | ||
| Uncovering the Patient’s Apparent and Not-so-Apparent Motivations for Suicide | 739 | ||
| Clinical Illustration of Step 1: Exploring the Region of Presenting Suicide Events | 740 | ||
| Step 2: The Exploration of Recent Suicide Events | 742 | ||
| Clinical Illustration of Step 2: Exploring the Region of Recent Events | 746 | ||
| Step 3: The Exploration of Past Suicide Events | 749 | ||
| Clinical Illustration of Step 3: Exploring the Region of Past Events | 750 | ||
| Step 4: The Exploration of Immediate Suicide Events | 752 | ||
| Clinical Illustration of Step 4: Exploring the Region of Immediate Events | 755 | ||
| Concluding Comments | 758 | ||
| References | 758 | ||
| 18 Exploring Violent and Homicidal Ideation | 763 | ||
| Introduction | 763 | ||
| Background | 763 | ||
| Characterizing Violence: Three Practical Domains for Clinicians | 764 | ||
| The Organization of the Chapter and the Role of Structured Risk Assessments | 766 | ||
| Part 1: Risk Factors for Violence | 767 | ||
| Past Violence | 767 | ||
| Sex, Age, and Environment | 767 | ||
| Presence of Psychiatric Disorders | 768 | ||
| Other Factors Suggested by the HCR-20 | 768 | ||
| Part 2: Clinical Formulation of Risk – the Tetrad of Lethality | 769 | ||
| 1. Patients Presenting With a Recent Violent Episode | 769 | ||
| 2. Patients Presenting With Dangerous Psychotic Process | 770 | ||
| Command Hallucinations, Alien Control, and Hyper-Religiosity | 771 | ||
| Uncovering Paranoid Process | 772 | ||
| Complexities of Spotting Individuals Contemplating Mass Murder and Other Paranoid-Induced Violence | 772 | ||
| 3. Indication From the Interview That the Patient Intends to Engage in Violence | 776 | ||
| 4. The Patient Is Lying and Collaborative Evidence Suggests Intended Violence | 776 | ||
| A Few Caveats Regarding Domestic Violence | 776 | ||
| Part 3: the Art of Eliciting Violent and Homicidal Ideation | 778 | ||
| Setting the Stage | 778 | ||
| Chronological Assessment of Dangerous Events (the CADE Approach) | 779 | ||
| Presenting Event | 779 | ||
| Exploration of Recent Violent Events | 780 | ||
| Elicitation of Past Violent Events | 785 | ||
| Elicitation of Immediate Violent or Homicidal Ideation | 786 | ||
| Conclusion | 787 | ||
| Transitional Directions to Part IV: Advanced Interviewing and Specialized Topics | 788 | ||
| References | 788 | ||
| IV Specialized Topics and Advanced Interviewing | 791 | ||
| To the Reader | 792 | ||
| Chapters | 792 | ||
| Appendices and Glossary | 792 | ||
| 19 Transforming Anger, Confrontation, and Other Points of Disengagement | e3 | ||
| Introduction | e3 | ||
| Part 1: Points of Disengagement – Core Definitions | e7 | ||
| The Nature of the Beast | e7 | ||
| Points of Disengagement: Type 1 – Moments of Angry Disengagement (MADS) | e7 | ||
| The Family of MADS: Three Siblings | e7 | ||
| 1. Confrontational Disagreements | e7 | ||
| Deconstructing Disagreement: The Significance of a Fallen Log Upon a Road | e7 | ||
| Not All Disagreements Are Bad | e8 | ||
| 2. Oppositional Behaviors | e10 | ||
| 3. Passive-Aggressive Attitudes | e11 | ||
| Points of Disengagement: Type 2 – Potentially Disengaging Questions (PDQs) | e13 | ||
| Part 2: Points of Disengagement – Developing A Contemporary Language for Their Navigation | e13 | ||
| Clinical Illustration of a Disengagement Point | e13 | ||
| Recognizing the Surface Structure of MADs and PDQs | e16 | ||
| Recognizing the Underground Structure of MADS and PDQs: Finding the Person Beneath the Anger | e18 | ||
| Learning to Move With MADs and PDQs: The “Agreement Continuum” | e21 | ||
| Three Specific Approaches for Transforming MADs and PDQs | e26 | ||
| 1. Content Responses to Disengagement Points | e26 | ||
| 2. Process Responses to Disengagement Points | e28 | ||
| Type 1 Process Response: Patient Asked to Look at the Interview Process and His or Her Behaviors in the Interview | e29 | ||
| Type 2 Process Response: Patient Asked to Look at His or Her Affect, Thoughts, Feelings, or Concerns | e30 | ||
| Type 3 Process Response: Clinician Shares Thoughts or Feelings Generated by the Patient’s Behavior in the Interview | e32 | ||
| Advantages of Process Responses to MADS and PDQs | e32 | ||
| Clinical Illustration of Process Responses to a PDQ | e32 | ||
| Process Responses Versus Content Responses in the Initial Interview: Which One and Why | e34 | ||
| 3. Sidetracking Disengagement Points | e35 | ||
| Our Transformational Language and Principles at Work: A Return Visit to Our Clinical Illustration | e36 | ||
| Part 3: Effectively Navigating Common MADs and PDQs | e42 | ||
| Disengagement Points Challenging the Clinician’s Competence | e42 | ||
| Handling Competency Questions Concerning a Trainee’s Lack of Experience | e46 | ||
| PDQs That Attempt to Gain Personal Information About the Clinician | e48 | ||
| Patient Requests: Yet Another Commonly Encountered PDQ | e51 | ||
| Transforming Awkward Situations Encountered With Psychotic Patients | e52 | ||
| Situational Roadblocks: The Unwilling Patient and Involuntary Commitments | e55 | ||
| Transforming Overt Hostility From Family Members | e60 | ||
| References | e65 | ||
| 20 Culturally Adaptive Interviewing | e67 | ||
| Introduction: A Reason to Be | e67 | ||
| Part 1: Definitions, Attitudes, and Goals – in Search of Culturally Adaptive Interviewing | e70 | ||
| Basic Definitions: Race, Ethnicity, and Culture | e70 | ||
| Culture | e70 | ||
| Race | e71 | ||
| Ethnicity | e71 | ||
| Definition of “Cultural Competency”: More Complicated Than It Looks | e72 | ||
| Towards a Third Culture | e74 | ||
| Culturally Adaptive Interviewing | e76 | ||
| Part 2: the Mystery of Cultural Identity – Unpacking Assumptions | e77 | ||
| Things Are Not Exactly What They Seem: Intersectionality and Prioritizing Cultural Identities | e77 | ||
| Intersectionality | e77 | ||
| Prioritizing Cultural Identities: A Framework for Simplifying the Complex | e78 | ||
| Clinical Illustration of the Impact of Prioritizing Cultural Identities | e79 | ||
| Part 3: Developing and Utilizing Cultural Literacy to Engage Patients and to Better Understand the Complexity of Their Problems | e81 | ||
| Using Cultural Literacy to Enhance Engagement | e81 | ||
| Acquired and Discovered Cultural Literacy | e81 | ||
| Acquired Cultural Literacy | e81 | ||
| Discovered Cultural Literacy | e85 | ||
| Using Cultural Literacy Effectively: Some Clinical Illustrations | e86 | ||
| The Story of Marin | e88 | ||
| Cultural Literacy as a Guidepost for Therapeutic Exploration: Three Important Gateways | e91 | ||
| Gateway | e91 | ||
| Gateway | e94 | ||
| Gateway | e96 | ||
| Basic Principles | e96 | ||
| Core Definitions | e101 | ||
| Heterosexual. | e101 | ||
| Lesbian. | e101 | ||
| Gay. | e101 | ||
| Bisexual. | e101 | ||
| Cross-Dresser or Transvestite. | e101 | ||
| Transgender. | e101 | ||
| Transsexual. | e101 | ||
| Intersex. | e102 | ||
| Genderqueer. | e102 | ||
| Relationship Terms. | e102 | ||
| Obsolete Terms. | e102 | ||
| Sensitively Raising the Topic of Sexuality and Gender Identification | e103 | ||
| Issues of Intersectionality, Loss, and Violence for Patients From the LGBT Community | e105 | ||
| Intersectionality | e105 | ||
| Potential Issues of Loss in the LGBT Community | e108 | ||
| Violence and Hate Crimes | e110 | ||
| Part 4: Cultural Disconnects – How to Prevent Them Before They Occur, Recognize Them as They Occur, and Transform Them Once They Occur | e111 | ||
| Before the Interview Begins: The Look Inward | e111 | ||
| Core Definitions Related to Prejudice | e113 | ||
| Traditional Prejudice. | e113 | ||
| Induced Prejudice. | e113 | ||
| Incorporated Prejudice. | e113 | ||
| Dominant Cultures: Emerging Theoretical Nuances and Clinical Implications | e114 | ||
| Telescoping Prejudice | e114 | ||
| Towards a More Sophisticated Understanding of Power Differentials | e115 | ||
| Uncovering Potential Prejudice Within Ourselves | e115 | ||
| Clinician Prejudice: Reflections in a Mirror | e115 | ||
| A Psychodynamic Mirror | e119 | ||
| Transforming Moments of Cultural Disconnection | e119 | ||
| Six-Step Transformation of Cultural Disconnects | e122 | ||
| Transforming Cultural Disconnects: Interviewing Illustrations | e122 | ||
| Interviewing Illustration | e124 | ||
| Interviewing Illustration | e127 | ||
| A Note on Working With Interpreters | e132 | ||
| Part 5: Practical Tips for Exploring Religion, Spirituality, and Framework for Meaning | e135 | ||
| Distinctions Between Religion, Spirituality, and Worldview | e138 | ||
| The Clinical Value of Exploring Spirituality | e140 | ||
| 1. Spiritual and religious explorations can improve engagement, enhancing the development of a therapeutic third culture. | e140 | ||
| 2. An understanding of the patient’s spirituality or, perhaps in a more overarching fashion, his or her worldview can increase a patient’s interest in utilizing medication or psychotherapy. | e141 | ||
| 3. At times patients may have a specific religious proscription against using medications and/or a specific form of psychotherapy. | e141 | ||
| 4. Although a patient may not have immediate spiritual opposition to a specific treatment recommendation, on an unconscious level the moral codes and values by which the patient was raised may still be active or hesitancies being voiced on the web or other popular cultural media may be active, resulting in concerns regarding a specific treatment. | e142 | ||
| 5. Spiritual crises can precipitate psychiatric symptoms. | e142 | ||
| 6. Spiritual explorations may uncover rigid and damaging beliefs. | e142 | ||
| 7. Spiritual explorations may uncover rich arenas for psychological growth and support. | e143 | ||
| 8. An exploration of a patient’s framework for meaning may help to instill resiliency and hope. | e143 | ||
| 9. An understanding of a patient’s worldview can provide critical information regarding suicide risk. | e143 | ||
| 10. Spiritual explorations may help short-circuit cultural/spiritual practices that could interfere or disrupt the healing process. | e143 | ||
| Handling Countertransference Regarding Spirituality and Worldview | e144 | ||
| Self-Disclosure Regarding Spirituality: Uses and Cautions | e145 | ||
| A Caveat on Self-Disclosure Pertaining to Cultural Diversity | e145 | ||
| Should a Clinician Self-Disclose Religious Affiliation in an Initial Interview? | e146 | ||
| What to Do if a Patient Asks, “What Is Your Religious Background?” or “Do You Believe in God?” | e149 | ||
| How to Sensitively Raise the Topics of Spirituality, God, and Goddess | e151 | ||
| Indirect Methods for Raising the Topic of Spirituality | e152 | ||
| Griffith and Griffith’s Three Indirect Strategies | e152 | ||
| 1. Sometimes patients will spontaneously use words, sometimes as points of emphasis (or even as a point of jest), that indirectly suggest a religious heritage. | e152 | ||
| 2. Sometimes patients may betray significant current religious issues and/or past concerns by showing a shift in affect when mentioning a religious issue in passing. | e152 | ||
| 3. If a patient brings up a religious or spiritual parable or metaphor that is common to a particular religion and/or spiritual tradition of which the interviewer has cultural awareness (cultural literacy), one can use this as a gateway for further exploration. | e152 | ||
| Indirect Exploration via Existential Questions | e153 | ||
| Direct Methods for Raising the Topic of Spirituality | e154 | ||
| Conclusion and Final Clinical Illustration | e155 | ||
| References | e156 | ||
| 21 Vantage Points | e161 | ||
| Exploration of the Attentional Vantage Points | e165 | ||
| Looking at the Patient | e165 | ||
| Looking With the Patient | e165 | ||
| Somatic Empathy | e166 | ||
| Deep and Surface Structure | e167 | ||
| Counterprojective Statements | e169 | ||
| Looking at Oneself | e173 | ||
| Looking Within Oneself | e175 | ||
| Intuitive Reactive Responses | e176 | ||
| Associational Responses | e178 | ||
| Transferential Responses | e178 | ||
| Fantasy | e179 | ||
| Exploration of the Conceptual Vantage Points | e181 | ||
| Assessment for Psychodynamic Psychotherapy | e181 | ||
| Recognizing the Developmental Level of the Patient’s Defense Mechanisms and Sense of Self | e182 | ||
| Gauging Therapy-Facilitative Characteristics | e183 | ||
| Using Interpretive Questions to Test for Psychodynamic Readiness | e186 | ||
| Structural Interviewing of Kernberg | e188 | ||
| Illustration 1 | e191 | ||
| Illustration 2 | e192 | ||
| Illustration 3 | e193 | ||
| Intuitive Vantage Point | e194 | ||
| References | e198 | ||
| 22 Motivational Interviewing (MI) | e201 | ||
| Introduction | e201 | ||
| Motivational Interviewing | e202 | ||
| Introduction to Motivational Interviewing | e202 | ||
| Definition | e202 | ||
| Spirit of MI | e203 | ||
| Development of MI | e203 | ||
| Core Principles and Techniques of MI | e205 | ||
| Four Guiding Interviewing Principles | e205 | ||
| 1. Resist the Righting Reflex | e205 | ||
| 2. Understand and Explore the Patient’s Motivations for Change | e206 | ||
| 3. Listen With Empathy | e206 | ||
| 4. Empower the Patient | e207 | ||
| OARS: Pivotal Interviewing Techniques for Applying the Principles of MI | e207 | ||
| Asking Open Questions | e207 | ||
| Cautionary Note | e208 | ||
| Affirming Responses | e208 | ||
| Affirmations Created by the Interviewer | e209 | ||
| Affirmations Created by the Patient | e211 | ||
| Reflective Listening | e212 | ||
| Deconstructing “Reflective Responses” | e214 | ||
| Summarizing | e216 | ||
| The Four Processes of Motivational Interviewing | e218 | ||
| Process | e218 | ||
| Process | e220 | ||
| Focusing Utilized in the Opening Phase of the Interview | e221 | ||
| Focusing Utilized in the Closing Phase of the Interview | e222 | ||
| EPE: Elicit – Provide – Elicit | e222 | ||
| Step 1 – Eliciting Permission | e222 | ||
| Asking Permission | e222 | ||
| Exploring Prior Knowledge | e223 | ||
| Querying Interest | e223 | ||
| Step 2 – Providing Information | e223 | ||
| Step 3 – Eliciting Feedback on the Information Provided | e223 | ||
| Process | e224 | ||
| Ambivalence, “Change Talk,” and “Sustain Talk” | e224 | ||
| Discrepancy | e226 | ||
| Process | e226 | ||
| Putting It All Together: An Illustrative Dialogue | e227 | ||
| The Bridge to Improving Medication Interest and Use | e234 | ||
| References | e235 | ||
| 23 Medication Interest Model (MIM) | e239 | ||
| Introduction | e239 | ||
| Part 1: “Nonadherence” – More Than Meets the Eye | e242 | ||
| Extent of the Problem | e242 | ||
| Nonadherence: The Nature of the Beast | e243 | ||
| Part 2: The MIM – Development and Roots | e244 | ||
| Development of the MIM | e244 | ||
| Roots of the MIM | e246 | ||
| Pulling on Clinician Wisdom | e246 | ||
| Pulling on the Wisdom of Educational Theory and Research on Clinical Interviewing | e246 | ||
| Part 3: The Spirit of the MIM | e248 | ||
| Collaborative Exploration: The Transformative Engine of the MIM | e248 | ||
| The Truth About So-Called Medication “Nonadherence” | e249 | ||
| In Search of a New Word | e252 | ||
| Part 4: The Choice Triad – The Foundation of the MIM | e254 | ||
| Part 5: Practical Interviewing Techniques and Strategies for Enhancing Medication Interest and Use | e257 | ||
| Building the Medication Alliance: Toolboxes for Collaborative Exploration | e257 | ||
| Section 1: Toolbox for the First Prescription | e260 | ||
| The Medication Passport | e260 | ||
| Follow-Up on Uncovering the Patient’s Medication Passport | e261 | ||
| The Past Prescribers Passport | e262 | ||
| Introducing Your Personal Approach to Using Medications to the Patient | e262 | ||
| Section 2: Toolboxes for the Three Steps of the Choice Triad | e267 | ||
| Toolbox for Step 1 of the Choice Triad | e267 | ||
| Wisdom From a Past Century | e267 | ||
| Techniques for Uncovering the Patient’s Priorities for Symptom Relief | e270 | ||
| What to Do When Patients Do Not Believe They Have a Mental Illness | e272 | ||
| The Diagnostic Passport | e272 | ||
| The “Heading for Common Ground” Strategy: A Practical Approach When Patient and Clinician Disagree About Diagnosis | e273 | ||
| Toolbox for Step 2 of the Choice Triad | e276 | ||
| Tying Medication Use to Achieving Positive Life Goals | e276 | ||
| What if the Disorder Has No Symptoms? | e279 | ||
| Toolbox for Step 3 of the Choice Triad | e282 | ||
| Where Does the Patient Weigh the Pros and Cons | e284 | ||
| Uncovering the Patient’s Pros and Cons on Axis | e285 | ||
| Opening the Door to a Medication Interest Discussion | e286 | ||
| Addressing the Patient’s Concerns About Dosage: An Invitation of Sorts | e286 | ||
| The Subtle Art of Exploring Side Effects | e288 | ||
| How to Present a Medication When One of the Potential Side Effects Is Death | e290 | ||
| Questions for Uncovering Positive Effects of Medications | e291 | ||
| Uncovering the Patient’s Pros and Cons on Axis | e292 | ||
| Techniques for Addressing Financial Costs | e292 | ||
| Techniques for Addressing Psychological Cost | e294 | ||
| The Hidden Cost: Inconvenience | e294 | ||
| The Tragic Cost: Disruptions in Relationships | e295 | ||
| The Lost Goals Cost | e296 | ||
| Uncovering the Patient’s Pros and Cons on Axis | e296 | ||
| Addressing Concerns About Personal Weakness | e297 | ||
| Addressing a Compelling Paradox Arising With Remission | e298 | ||
| Questions for Ascertaining the Patient’s Ongoing Views About Continuing Medications | e299 | ||
| Exploring the Choice Triad: the Importance of Sequence | e300 | ||
| Section 3: Specialty Toolboxes for Difficult Clinical Challenges | e301 | ||
| Toolbox for Assessing the Patient’s Actual Medication Practices | e301 | ||
| Toolbox for Assessing Cultural Influences Upon Medication Interest | e303 | ||
| Assessing the Influence of Other Healers | e304 | ||
| Uncovering Cultural Biases About Medications | e306 | ||
| Caveats Concerning the Use of Generics | e310 | ||
| Toolbox for Assessing the Impact of the Web and Other Media on Your Patient’s Medication Interest | e311 | ||
| Toolbox for Assessing the Impact of Friends and Family on Your Patient’s Medication Interest | e312 | ||
| Toolbox for Medicating an Angrily Escalating Patient Involuntarily | e314 | ||
| Conclusion to the Book | e318 | ||
| References | e318 | ||
| Appendix I An Introduction to the Facilic Schematic System – A Shorthand for Supervisors and Supervisees (Interactive Computer Module) | e321 | ||
| Background and Foundation | e321 | ||
| Making a Longitudinal Facilic Map: Tricks of the Trade | e322 | ||
| Making a Cross-Sectional Map | e326 | ||
| Interactive Exercises for Consolidating the Understanding and Use of Facilic Shorthand | e327 | ||
| Exercise | e328 | ||
| Directions | e328 | ||
| Exercise | e329 | ||
| Answer to Exercise | e329 | ||
| Discussion | e329 | ||
| Exercise | e330 | ||
| Directions | e330 | ||
| Exercise | e331 | ||
| Answer to Exercise | e331 | ||
| Discussion | e331 | ||
| Exercise | e332 | ||
| Directions | e332 | ||
| Exercise | e333 | ||
| Answer to Exercise | e333 | ||
| Discussion | e333 | ||
| Exercise | e334 | ||
| Directions | e334 | ||
| Exercise | e335 | ||
| Answer to Exercise | e335 | ||
| Discussion | e335 | ||
| Exercise | e337 | ||
| Directions | e337 | ||
| Exercise | e338 | ||
| Answer to Exercise | e338 | ||
| Discussion | e338 | ||
| Exercise | e340 | ||
| Directions | e340 | ||
| Exercise | e341 | ||
| Answer to Exercise | e341 | ||
| Discussion | e341 | ||
| Exercise | e342 | ||
| Directions | e342 | ||
| Exercise | e343 | ||
| Answer to Exercise | e343 | ||
| Discussion | e343 | ||
| Exercise | e344 | ||
| Directions | e344 | ||
| Exercise | e345 | ||
| Answer to Exercise | e345 | ||
| Discussion | e345 | ||
| Exercise | e346 | ||
| Directions | e346 | ||
| Exercise | e347 | ||
| Answer to Exercise | e347 | ||
| Discussion | e347 | ||
| Exercise | e348 | ||
| Directions | e348 | ||
| Exercise | e349 | ||
| Answer to Exercise | e349 | ||
| Discussion | e349 | ||
| Exercise | e351 | ||
| Directions | e351 | ||
| Exercise | e352 | ||
| Answer to Exercise | e352 | ||
| Discussion | e352 | ||
| Exercise | e353 | ||
| Directions | e353 | ||
| Exercise | e354 | ||
| Answer to Exercise | e354 | ||
| Discussion | e354 | ||
| References | e327 | ||
| Appendix II Annotated Initial Interview (Direct Transcript) | e356 | ||
| Annotation: | e356 | ||
| Start of Interview | e356 | ||
| Appendix III The Written Document/Electronic Health Record (EHR): Effective Strategies | e396 | ||
| Appendix IIIA Practical Tips for Creating a Good EHR/EMR Document | e401 | ||
| History of the Present Illness | e401 | ||
| Narrative Summary and Formulation | e403 | ||
| Assessment of Suicide and Violence Potential | e405 | ||
| Appendix IIIB Prompts and Quality Assurance Guidelines for the Written Document | e408 | ||
| Prompts for the Initial Clinical Assessment | e408 | ||
| Quality Assurance Guidelines for the Written Document | e409 | ||
| Appendix IIIC Sample Written Assessment | e412 | ||
| Initial Clinical Assessment | e412 | ||
| I Identification, Chief Complaint, and Reason for Referral | e412 | ||
| II History of the Present Illness | e412 | ||
| III Past Psychiatric History | e413 | ||
| IV History of Substance Abuse | e413 | ||
| V Past Social and Developmental History | e413 | ||
| VI Current Social History | e414 | ||
| VII Family History | e414 | ||
| VIII Medical History and Review of Systems | e415 | ||
| IX Mental Status Examination | e415 | ||
| X DSM-5 Diagnosis | e416 | ||
| Psychiatric Disorders (Excluding Personality Dysfunction) | e416 | ||
| Personality Disorders | e416 | ||
| Medical Disorders | e416 | ||
| XI Narrative Summary and Formulation | e416 | ||
| Appendix IIID Sample Initial Clinical Assessment Form | e418 | ||
| Appendix IV Supplemental Articles From the Psychiatric Clinics of North America | e425 | ||
| Group A: Articles for Clinicians and Trainees | e425 | ||
| Group B: Articles for Faculty and Interviewing Mentors | e425 | ||
| Glossary of Interview Supervision Terms | e426 | ||
| Index | 795 | ||
| A | 795 | ||
| B | 799 | ||
| C | 801 | ||
| D | 805 | ||
| E | 810 | ||
| F | 813 | ||
| G | 814 | ||
| H | 815 | ||
| I | 816 | ||
| J | 822 | ||
| K | 822 | ||
| L | 822 | ||
| M | 823 | ||
| N | 827 | ||
| O | 828 | ||
| P | 829 | ||
| Q | 836 | ||
| R | 836 | ||
| S | 838 | ||
| T | 843 | ||
| U | 845 | ||
| V | 845 | ||
| W | 847 | ||
| Y | 848 | ||
| Z | 848 |